Background Cardiovascular disease (CVD) is the primary cause of mortality and morbidity in patients with type 2 diabetes. N-terminal pro-brain natriuretic peptide (NT-proBNP), which is a useful biomarker of chronic heart failure, has been shown to be a strong predictor of cardiovascular mortality. Furthermore, alterations in vascular structure and function are also recognized increasingly as significant independent predictors of adverse cardiovascularoutcomes. In this study, we investigated the relationships between NT-proBNP and markers of subclinical atherosclerosis in patients with type 2 diabetes. Methods Relationships of NT-proBNP to pulse wave velocity (PWV) or ankle-brachial index (ABI) as wellas to major metabolic risk parameters, including body mass index, blood pressure, serum lipid concentration, serum uric acid concentration,and glycemic control (hemoglobinA1c), age, hemoglobin, serum creatinine concentration, severity of diabetic nephropathy orretinopathy, current treatment of diabetes, smoking status, and presence of CVD were investigated in 323 consecutive patients with type 2 diabetes. Results Log (NT-proBNP) correlated positively with PWV (r = 0.283, p < 0.0001) and correlated negatively with ABI (r = −0.144, p = 0.0094). Multiple regression analysis demonstrated that age (β = 0.267, p < 0.0001), systolic blood pressure (β = 0.249, p < 0.0001), uric acid (β = 0.121, p = 0.0383), creatinine (β = −0.139, p = 0.0239) and log (NT-proBNP) (β = 0.173, p = 0.0043) were independent determinants of PWV and that log triglyceride (β = −0.130, p = 0.0390) andlog (NT-proBNP) (β = −0.153 p = 0.0256) were independent determinants of ABI. Conclusions NT-proBNP was associated with PWV and ABI in patients with type 2 diabetes. NT-proBNP could be a marker of subclinical atherosclerosis in patients with type 2 diabetes.